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1.
J Med Case Rep ; 15(1): 111, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653404

RESUMO

BACKGROUND: Most sudden-onset hearing loss is due to otolaryngologic- and very rarely to cerebrovascular disease. We report a woman with sudden bilateral sensorineural hearing loss. This case suggests that even in the absence of brainstem or cerebellar signs, magnetic resonance imaging (MRI) and MR angiography (MRA) should be performed since such studies may reveal signs of life-threatening vertebrobasilar artery occlusion. CASE PRESENTATION: A 73-year-old Japanese woman with a history of hypertension, hyperlipidemia, and atrial fibrillation who suffered bilateral deafness with vertigo and vomiting was transferred from a local hospital to our department. On admission her consciousness was clear and vertigo was absent. Neurological examination revealed only bilateral sensorineural hearing loss. Head computed tomography (CT) returned no significant findings. The next morning she gradually developed severe drowsiness. Diffusion-weighted MRI demonstrated acute cerebral infarction in the brainstem and bilateral cerebellum; MRA showed basilar artery occlusion due to a cardioembolic thrombus. Revascularization was obtained by endovascular treatment. However, her condition worsened progressively during the following hours. CT revealed new brainstem lesions, massive cerebellar swelling, and obstructive hydrocephalus. She died on the second day after her admission. CONCLUSIONS: When hearing loss is due to vertebrobasilar occlusive disease, the prognosis is very poor. We suggest that vertebrobasilar stroke be suspected in patients with bilateral sensorineural hearing loss who present with risk factors for stroke such as atrial fibrillation and other neurologic signs.


Assuntos
Infartos do Tronco Encefálico/complicações , Doenças Cerebelares/complicações , Perda Auditiva Bilateral/etiologia , Perda Auditiva Súbita/etiologia , Diagnóstico Ausente , Insuficiência Vertebrobasilar/complicações , Idoso , Fibrilação Atrial/complicações , Artéria Basilar/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Hiperlipidemias/complicações , Hipertensão/complicações , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Artéria Vertebral/diagnóstico por imagem , Insuficiência Vertebrobasilar/diagnóstico por imagem
2.
J Stroke Cerebrovasc Dis ; 30(5): 105680, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33652344

RESUMO

INTRODUCTION: Body lateropulsion (BLP) is seen in neurological lesions involving the pathways responsible for body position and verticality. We report a case of isolated body lateropulsion (iBLP) as the presentation of lateral medullary infarction and conducted a systematic literature review. METHODS: MEDLINE and EMBASE databases were searched up to December 3, 2020. INCLUSION CRITERIA: age ≥ 18, presence of BLP, confirmed stroke on imaging. EXCLUSION CRITERIA: age < 18, qualitative reviews, studies with inadequate patient data. Statistical analysis was performed using IBM® SPSS® Statistics 20. RESULTS: A 64-year-old man presented with acute-onset iBLP. Brain MRI demonstrated acute infarction in the right caudolateral medulla. His symptoms progressed with ipsilateral Horner syndrome over the next 24 hours and contralateral hemisensory loss 10 days later. Repeat MRI showed an increase in infarct size. BLP resolved partially at discharge. Systematic review: 418 abstracts were screened; 59 studies were selected reporting 103 patients. Thirty-three patients had iBLP (32%). BLP was ipsilateral to stroke in 70 (68%) and contralateral in 32 (32%). The most common stroke locations were medulla (n = 63, 59%), pons (n = 16, 15%), and cerebellum (n = 16, 15%). Four strokes were cortical, 3 frontal and 1 temporoparietal (3%). The most common etiology was large-artery atherosclerosis (LAA) in 20 patients (32%), followed by small-vessel occlusion in 12 (19%). Seventeen (27%) had large-vessel occlusion (LVO), 12 involving the vertebral artery. Sixty (98%) had some degree of resolution of BLP; complete in 41 (70%). Median time-to-resolution was 14 days (IQR 10-21). There was no relationship between time-to-resolution and age, sex, side of BLP or side of stroke. CONCLUSION: BLP was commonly seen with medullary infarction and was the isolated finding in one-third. LAA and LVO were the most common etiologies. Recovery of BLP was early and complete in most cases.


Assuntos
Infartos do Tronco Encefálico/complicações , Equilíbrio Postural , Transtornos das Sensações/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Síndrome de Horner/etiologia , Síndrome de Horner/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia
3.
J Stroke Cerebrovasc Dis ; 30(4): 105621, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33581546

RESUMO

Here we describe a case of brainstem infarction secondary to rapid thrombus formation in a giant vertebrobasilar fusiform aneurysm (GVBFA) that was preceded clinically by several months of headaches and dizziness initially attributable to mass effect. Less than a month after initial identification of the aneurysm, a large partially-occluding thrombus formed leading to infarction of the brainstem. Interestingly, this patient also had ulcerative colitis, which has been associated with acquired hypercoagulability. Balancing risk versus benefit in the management of GVBFA to prevent morbidity and mortality is very challenging; thus more information is needed to better stratify treatment options for patients, particularly those that may have an accelerating clinical course or co-morbidities that increase clotting risk.


Assuntos
Infartos do Tronco Encefálico/etiologia , Colite Ulcerativa/complicações , Aneurisma Intracraniano/complicações , Trombose Intracraniana/etiologia , /etiologia , Idoso , Anticoagulantes/uso terapêutico , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Colite Ulcerativa/diagnóstico , Progressão da Doença , Evolução Fatal , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/tratamento farmacológico , Trombose Intracraniana/diagnóstico por imagem , Trombose Intracraniana/tratamento farmacológico , /tratamento farmacológico , Masculino , Inibidores da Agregação de Plaquetas/uso terapêutico , Fatores de Risco
4.
J Stroke Cerebrovasc Dis ; 30(4): 105623, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33486342

RESUMO

In the present report, we discussed the case of a 57-year-old man with unilateral masticatory muscle weakness, nystagmus, skew deviation and facial hypesthesia due to pontine tegmental infarction. Trigeminal motor neuropathy attributed to brain infarction is very rare. Brain magnetic resonance imaging revealed a small dot-like infarction lesion in the pontine tegmentum. Masticatory muscle weakness was confirmed by an electrophysiological study performed on the day after admission in which there was an incomplete interference pattern without spontaneous denervation activity, suggesting that the patient's masseter muscle weakness was caused by an infarction of the trigeminal motor nucleus proper or trigeminal motor nerve fascicles rather than Wallerian degeneration of the trigeminal nerve or the progression of masseter muscle degeneration.


Assuntos
Infartos do Tronco Encefálico/complicações , Paralisia Facial/etiologia , Músculo Masseter/inervação , Debilidade Muscular/etiologia , Núcleo Motor do Nervo Trigêmeo/irrigação sanguínea , Doenças do Nervo Trigêmeo/etiologia , Doença Aguda , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Paralisia Facial/diagnóstico , Paralisia Facial/fisiopatologia , Humanos , Masculino , Mastigação , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/fisiopatologia , Doenças do Nervo Trigêmeo/diagnóstico , Doenças do Nervo Trigêmeo/fisiopatologia
5.
BMJ Case Rep ; 13(11)2020 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-33148560

RESUMO

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Assuntos
Aspirina/administração & dosagem , Fibrilação Atrial , Cegueira , Infartos do Tronco Encefálico , Infecções por Coronavirus , Diplopia , Endocardite Bacteriana , Oftalmoplegia , Pandemias , Pneumonia Viral , Pirazóis/administração & dosagem , Piridonas/administração & dosagem , Oclusão da Artéria Retiniana , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Betacoronavirus/isolamento & purificação , Cegueira/diagnóstico , Cegueira/etiologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/tratamento farmacológico , Infartos do Tronco Encefálico/fisiopatologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diplopia/diagnóstico , Diplopia/etiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/fisiopatologia , Inibidores do Fator Xa/administração & dosagem , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Inibidores da Agregação de Plaquetas/administração & dosagem , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Oclusão da Artéria Retiniana/diagnóstico por imagem , Oclusão da Artéria Retiniana/tratamento farmacológico , Oclusão da Artéria Retiniana/etiologia , Oclusão da Artéria Retiniana/fisiopatologia , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
6.
J Vis Exp ; (162)2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32925875

RESUMO

Pontine infarction is the most common stroke subtype in the posterior circulation, while there lacks a rodent model mimicking pontine infarction. Provided here is a protocol for successfully establishing a rat model of acute pontine infarction. Rats weighing about 250 g are used, and a probe with an insulated sheath is injected into the pons using a stereotaxic apparatus. A lesion is produced by the electrical stimulation with a single pulse. The Longa score, Berderson score, and beam balance test are used to assess neurological deficits. Additionally, the adhesive-removal somatosensory test is used to determine sensorimotor function, and the limb placement test is used to evaluate proprioception. MRI scans are then used to assess the infarction in vivo, and TTC staining is used to confirm the infarction in vitro. Here, a successful infarction is identified that is located in the anterolateral basis of the rostral pons. In conclusion, a new method is described to establish an acute pontine infarction rat model.


Assuntos
Infartos do Tronco Encefálico/patologia , Ponte/patologia , Doença Aguda , Animais , Comportamento Animal , Infartos do Tronco Encefálico/diagnóstico por imagem , Modelos Animais de Doenças , Estimulação Elétrica , Imagem por Ressonância Magnética/métodos , Masculino , Ponte/diagnóstico por imagem , Ratos Sprague-Dawley
7.
J Stroke Cerebrovasc Dis ; 29(10): 105183, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912551

RESUMO

BACKGROUND: In patients with lower lateral medullary infarction (LMI) located under the vestibular nucleus, proprioceptive impairment due to dorsal spinocerebellar tract (DSCT) is considered a pathological condition for body lateropulsion. In patients with brainstem infarction located at or above the level of the vestibular nucleus, other pathways, such as the crossed vestibulothalamic tract (CVTT), are considered responsible. RESEARCH QUESTION: The clinical course of body lateropulsion between each anatomical level of infarction remains unclear. Further, whether body lateropulsion refers to a static or a dynamic symptom also remains unclear. METHODS: We examined 47 patients who exhibited body lateropulsion and categorized them into four groups: lower LMI under the vestibular nucleus, LMI at the level of the vestibular nucleus, pontine infarction, and midbrain infarction. The patients' time to acquire static upright standing position and gait in a straight line were statistically analyzed by a log-rank test using the Kaplan-Meier method. RESULTS: Body lateropulsion in the static upright position was less frequent in the lower LMI group than in the other groups. SIGNIFICANCE: Lower LMI primarily affected body lateropulsion in gait. DSCT damage could affect ipsilateral hip joint or leg coordination, causing body lateropulsion in dynamic situation.


Assuntos
Infartos do Tronco Encefálico/fisiopatologia , Marcha , Extremidade Inferior/irrigação sanguínea , Mesencéfalo/irrigação sanguínea , Atividade Motora , Ponte/irrigação sanguínea , Postura , Propriocepção , Núcleos Vestibulares/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/psicologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade
8.
J Stroke Cerebrovasc Dis ; 29(10): 105163, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912561

RESUMO

Acute pure motor hemiparesis can occur due to a vascular insult along the cortico spinal pathway. Rarely such a stroke can occur as a result of involvement of the pyramids located on the ventral aspect of the medulla. Neurological localization can be difficult in such strokes and moreover they can also pose imaging challenges since they are missed on the CT scans. So far only 4 such cases have been reported in literature. Here we present two cases of pure motor strokes caused by infarction of the medullary pyramids. We have described the anatomical correlates of the symptoms and signs and also highlight the importance of MRI in picking up these rare strokes.


Assuntos
Infartos do Tronco Encefálico/complicações , Infarto Cerebral/complicações , Bulbo/irrigação sanguínea , Músculo Esquelético/inervação , Paresia/etiologia , Tratos Piramidais/irrigação sanguínea , Idoso , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/fisiopatologia , Avaliação da Deficiência , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurônios Motores , Paresia/diagnóstico , Paresia/fisiopatologia , Tomografia Computadorizada por Raios X
9.
Medicine (Baltimore) ; 99(32): e21530, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769891

RESUMO

RATIONALE: Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration. PATIENT CONCERNS: Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only. DIAGNOSES: Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography. INTERVENTION: High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanism of stroke associated with BA fenestration. OUTCOMES: No plaque was observed at the area of BA fenestration from high-resolution MRI. 4D flow MRI showed bifurcated flow with high flow velocity and low shear stress at the area of BA fenestration. LESSONS: A turbulent flow with high flow velocity and low shear stress at the BA fenestration area may have influenced the flow through the bilateral perforating arteries resulting in a bilateral symmetric pontine infarction with sparing the midline where the septa of BA is located. 4D flow dynamic studies may be beneficial for verifying the mechanism of stroke.


Assuntos
Artéria Basilar/anormalidades , Infartos do Tronco Encefálico/congênito , Disartria/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Artéria Basilar/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Disartria/etiologia , Humanos , Angiografia por Ressonância Magnética , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte , Acidente Vascular Cerebral/congênito
10.
Acta Neuropathol Commun ; 8(1): 147, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847628

RESUMO

We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.


Assuntos
Infartos do Tronco Encefálico/patologia , Doenças Cerebelares/patologia , Infecções por Coronavirus/patologia , Hemorragias Intracranianas/patologia , Microglia/patologia , Neurônios/patologia , Fagocitose , Pneumonia Viral/patologia , Idoso , Betacoronavirus , Infartos do Tronco Encefálico/complicações , Infartos do Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Núcleos Cerebelares/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Cefaleia/etiologia , Parada Cardíaca/etiologia , Humanos , Hipóxia/etiologia , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Bulbo/diagnóstico por imagem , Bulbo/patologia , Núcleo Olivar/patologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Tegmento Pontino/diagnóstico por imagem , Tegmento Pontino/patologia , Tomografia Computadorizada por Raios X
11.
J Stroke Cerebrovasc Dis ; 29(8): 104937, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689600

RESUMO

BACKGROUND AND PURPOSE: Acute vestibular syndrome (AVS) is a common cause of emergency admittance and has very rarely been reported due to a vestibular nucleus infarction. Initial magnetic resonance imaging studies (MRIs) including diffusion-weighted images may reveal normal results and even bedside examination tests like HINTS battery which involves head impulse test (HIT), nystagmus and test of skew can be challenging in differing a peripheral vestibulopathy from a central lesion. METHODS: Four patients seen in the emergency department with AVS and evaluated with HINTS battery, cervical vestibular-evoked myogenic potentials (cVEMP) and cranial MRI revealing infarcts restricted to vestibular nuclei were evaluated. RESULTS: In two patients spontaneous nystagmus beating towards the unaffected side was present. In one patient spontaneous nystagmus changed direction on looking to the affected side. In the fourth gaze evoked nystagmus was present without any spontaneous nystagmus. In all, HIT was positive to the affected side. In three cVEMPs was studied revealing delayed latency, reduced amplitude p13/n23 potentials on the lesioned side in two of them. Initial MRIs including diffusion-weighted images disclosed acute infarction in the area of the vestibular nuclei in two patients, with normal results in the other two. Follow-up MRI's performed 48 hours later revealed vestibular nuclear infarction. CONCLUSION: It is not always easy to differentiate small lesions restricted to central vestibular structures from peripheral vestibular lesions both on clinical and radiological grounds. Follow-up cranial MRI is necessary in patients with known vascular risk factors.


Assuntos
Infartos do Tronco Encefálico/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Núcleos Vestibulares/diagnóstico por imagem , Idoso , Infartos do Tronco Encefálico/tratamento farmacológico , Infartos do Tronco Encefálico/fisiopatologia , Diagnóstico Diferencial , Teste do Impulso da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico , Inibidores da Agregação de Plaquetas/uso terapêutico , Valor Preditivo dos Testes , Tempo de Reação , Resultado do Tratamento , Potenciais Evocados Miogênicos Vestibulares , Núcleos Vestibulares/fisiopatologia
13.
J Stroke Cerebrovasc Dis ; 29(6): 104750, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220556

RESUMO

Isolated pontine infarcts are common and are often associated with well-described syndromes that are classified based on their specific clinical presentation and arterial stroke territories. Here we present a case of acute combined diplopia and unilateral lower extremity sensory abnormality. Diffusion-weighted magnetic resonance imaging revealed a punctate area of acute ischemia in the right medial pontine mid-tegmentum. These findings suggest a unique pontine stroke syndrome characterized by acute ischemic injury at the intersection of the medial lemniscus and cranial nerve VI.


Assuntos
Doenças do Nervo Abducente/etiologia , Infartos do Tronco Encefálico/complicações , Diplopia/etiologia , Extremidade Inferior/inervação , Tegmento Pontino/irrigação sanguínea , Transtornos das Sensações/etiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Diplopia/diagnóstico , Diplopia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Tegmento Pontino/diagnóstico por imagem , Valor Preditivo dos Testes , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Síndrome
14.
Cerebrovasc Dis ; 49(1): 105-109, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32062661

RESUMO

BACKGROUND: In acute infarction patients, small cortical cerebellar infarctions (SCCI) on MRI (assessed on diffusion-weighted imaging, with SCCI often chronic and asymptomatic) are associated with acute cardioembolic infarction. In young cryptogenic stroke patients, patent foramen ovale (PFO) is thought to be a potential source of cardioembolic infarction. We hypothesize that SCCI on MRI would be associated with PFO in young cryptogenic stroke patients. METHODS: A total of 321 consecutive young (≤50 years) stroke patients admitted between January 2015 and July 2019 were screened. Of these patients, 287 patients had diagnostic work-up including early-phase MRI, intra- and extracranial vessel imaging, contrast transoesophageal or contrast transthoracic echocardiography, and ≥24 h ECG-monitoring. We retrospectively analyzed MRI scans of the 112 patients with cryptogenic stroke, including 63 with and 49 without PFO. Between both groups, we compared baseline characteristics (including cardiovascular risk factors and history of stroke), MRI characteristics of acute symptomatic infarction (cortical/subcortical localization, arterial territory, lesion number, and lesion size in case of subcortical infarction), atrial septum aneurysm (ASA) presence, and acute and chronic SCCI and non-SCCI lesions assessed on diffusion-weighted imaging. RESULTS: Groups with and without PFO were comparable in regard to performed vessel imaging and echocardiography modalities, baseline characteristics, and acute infarction characteristics, except for more frequent current smoking (67 vs. 44%, p = 0.022) and multiterritorial infarction (14 vs. 0%, p = 0.0024) and less frequent ASA (10 vs. 48%, p < 0.001) in the group without PFO. Risk of Paradoxal Embolism score was >6 in 76% of patients with PFO. SCCI was more frequent in patients with than without PFO (33 vs. 10%, p = 0.0061; OR 4.4, 95% CI 1.5-12.7), with chronic and asymptomatic SCCI in the vast majority of cases. No difference was observed for non-SCCI lesions. CONCLUSIONS: Chronic SCCI are strongly associated with PFO in young cryptogenic stroke patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04043559.


Assuntos
Infartos do Tronco Encefálico/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Embolia Paradoxal/diagnóstico por imagem , Forame Oval Patente/diagnóstico por imagem , Adulto , Fatores Etários , Infartos do Tronco Encefálico/etiologia , Doença Crônica , Bases de Dados Factuais , Embolia Paradoxal/etiologia , Feminino , Forame Oval Patente/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
15.
Can Assoc Radiol J ; 71(2): 186-194, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063011

RESUMO

The tectal plate comprises the posterior portion of the midbrain, borders the quadrigeminal cistern, and includes the superior and inferior colliculi. Benign and malignant pathologies occurring in this location may lead to aqueductal stenosis, obstructive hydrocephalus, and Parinaud syndrome. Both computed tomography and magnetic resonance imaging can be used to further characterize lesions involving the tectal plate. In this pictorial essay, we review various tectal plate lesions and their imaging features.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Cistos/diagnóstico por imagem , Glioma/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Teto do Mesencéfalo/diagnóstico por imagem , Abscesso Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/secundário , Lipoma/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem
16.
World Neurosurg ; 137: 292-295, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32068170

RESUMO

BACKGROUND: Lumbar puncture is a common procedure that can be safely performed in most patients. Certain populations may have increased risk for complications following lumbar puncture, but the significance of basilar invagination is often underappreciated. CASE DESCRIPTION: A 45-year-old woman with basilar invagination received multiple lumbar punctures in the workup of acute meningitis. Preprocedural computed tomography was obtained. Following lumbar puncture, the patient developed locked-in syndrome. Magnetic resonance imaging obtained several days later demonstrated severe compression and infarction of the medulla and inferior cerebellum by the odontoid process and ectopic cerebellar tonsils. The patient was transferred but at this point, surgical decompression was not possible. She did not regain significant neurologic function. CONCLUSIONS: Basilar invagination is a risk factor for devastating neurologic complications following lumbar puncture. Awareness of this complication and prompt recognition of its occurrence may prevent future morbidity of lumbar puncture in patients with basilar invagination.


Assuntos
Infartos do Tronco Encefálico/diagnóstico por imagem , Síndrome do Encarceramento/diagnóstico , Bulbo/irrigação sanguínea , Bulbo/diagnóstico por imagem , Meningite Pneumocócica/diagnóstico , Platibasia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Punção Espinal/efeitos adversos , Infartos do Tronco Encefálico/etiologia , Cerebelo/anormalidades , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Síndrome de Klippel-Feil/complicações , Síndrome de Klippel-Feil/cirurgia , Síndrome do Encarceramento/diagnóstico por imagem , Síndrome do Encarceramento/etiologia , Imagem por Ressonância Magnética , Meningite Pneumocócica/complicações , Pessoa de Meia-Idade , Processo Odontoide/anormalidades , Processo Odontoide/diagnóstico por imagem , Platibasia/complicações , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Fusão Vertebral , Streptococcus pneumoniae , Tomografia Computadorizada por Raios X
18.
Saudi Med J ; 40(12): 1278-1284, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31828281

RESUMO

We aimed to present a case of symmetrical Wallerian degeneration (WD) in the middle cerebellar peduncles (MCPs) after a unilateral paramedian pontine infarction, which was examined by multimodality magnetic resonance imaging (MRI). In addition, we summarize the small number of reported cases. In our clinic, we observed a case of symmetrical WD of bilateral MCPs that occurred 6 months after the onset of a pontine infarction. We searched the Wanfang (Chinese) and PubMed databases and found 23 reported cases of this condition with characteristic similar to our patient. From the 24 cases, the detection time of WD ranged from 3 to 33 weeks. Symmetrical WD in the bilateral MCPs can occur after unilateral paramedian pontine infarction. Most cases were in Stages 2 and 3 of the disease and showed good clinical prognoses.


Assuntos
Infartos do Tronco Encefálico/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Degeneração Walleriana/diagnóstico por imagem , Idoso , Infartos do Tronco Encefálico/fisiopatologia , Seguimentos , Humanos , Masculino , Degeneração Walleriana/fisiopatologia
19.
Med Sci Monit ; 25: 9585-9593, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31838483

RESUMO

BACKGROUND The aim of this study was to investigate whether patients with basal ganglia stroke and patients with pontine stroke have different types of functional connectivity (FC) alterations in the early chronic phase. MATERIAL AND METHODS We included 14 patients with pontine stroke, 17 patients with basal ganglia stroke, and 20 well-matched healthy controls (HCs). All of them underwent resting-state functional magnetic resonance imaging (rs-fMRI) scanning. The independent component analysis (ICA) approach was applied to extract information regarding the default-mode network (DMN), including anterior DMN (aDMN) and posterior DMN (pDMN) components and the sensorimotor network (SMN). RESULTS Compared with HCs, patients with basal ganglia stroke exhibited significantly reduced FC in the left precuneus of the pDMN, right supplementary motor area (SMA), and right superior frontal gyrus (SFG) of the SMN. Additionally, FC in the left medial prefrontal gyrus (MFG) of the aDMN, right precuneus and right posterior cingulate cortex (PCC) of the pDMN, and left middle cingulate gyrus (mid-CC) of the SMN decreased in patients with pontine stroke. CONCLUSIONS The different patterns of FC damage in patients with basal ganglia stroke and patients with pontine stroke in the early chronic phase may provide a new method for investigating lesion-induced network plasticity.


Assuntos
Infartos do Tronco Encefálico/fisiopatologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Idoso , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/fisiopatologia , Encéfalo/fisiopatologia , Mapeamento Encefálico/métodos , Infartos do Tronco Encefálico/diagnóstico por imagem , Conectoma/métodos , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vias Neurais , Descanso , Córtex Sensório-Motor/diagnóstico por imagem , Córtex Sensório-Motor/metabolismo
20.
Neuroimage Clin ; 24: 102090, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31835285

RESUMO

BACKGROUND AND PURPOSE: Early studies have indicated that the cortico-rubro-spinal tracts play important roles in motor dysfunction after stroke. However, the differential involvement of the rubral branches in capsular and pontine stroke, and their associations with the motor impairment are still unknown. METHODS: The present study recruited 144 chronic stroke patients and 91 normal controls (NC) from three hospitals, including 102 cases with capsular stroke (CS) and 42 cases with pontine stroke (PS). The rubral branches, including bilateral corticorubral tracts (CRT), dentatorubral tracts (DRT), and rubrospinal tracts (RST), and the cortico-spinal tract (CST) were reconstructed based on the dataset of the Human Connectome Project. Group differences in diffusion scalars of each rubral branch were compared, and the associations between the diffusion measures of rubral branches and the Fugl-Meyer assessment (FMA) scores were tested. RESULTS: The bilateral CRT of the CS cases showed significantly lower factional anisotropy (FA) than in the NC. The bilateral DRT of the PS cases had lower FA than in the NC. Both CS and PS cases had significantly lower FA of the bilateral RST than the NC. Besides, the stroke patients demonstrated significantly lower FA in bilateral CSTs than the NC. Partial correlation analysis identified significantly positive correlations between the FA of the ipsilesional and CRT and the FMA scores in the CS group, and significantly positive correlations between the FA of the RST bilaterally and the FMA scores in the CS and PS groups. Furthermore, the association between RST integrity and FMA scores still survived after controlling for the effect of the CST. Finally, multiple regression modelling found that rubral tract FA explained 39.2% of the variance in FMA scores for CS patients, and 48.8% of the variance in FMA scores for PS patients. CONCLUSIONS: The bilateral rubral branches were differentially involved in the chronic capsular and pontine stroke, and the impairment severity of each rubral branch was dependent on lesion locations. The integrity of the rubral branches is related to motor impairment in both the chronic capsular and pontine stroke.


Assuntos
Doença Cerebrovascular dos Gânglios da Base/diagnóstico por imagem , Infartos do Tronco Encefálico/diagnóstico por imagem , Núcleos Cerebelares/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Tratos Piramidais/diagnóstico por imagem , Núcleo Rubro/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Adulto , Idoso , Anisotropia , Doença Cerebrovascular dos Gânglios da Base/fisiopatologia , Infartos do Tronco Encefálico/fisiopatologia , Estudos de Casos e Controles , Núcleos Cerebelares/fisiopatologia , Córtex Cerebral/fisiopatologia , Doença Crônica , Conectoma , Imagem de Tensor de Difusão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Ponte/irrigação sanguínea , Tratos Piramidais/fisiopatologia , Núcleo Rubro/fisiopatologia , Medula Espinal/fisiopatologia , Acidente Vascular Cerebral/fisiopatologia , Substância Branca/irrigação sanguínea , Substância Branca/fisiopatologia
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